S

scleritis An INFLAMMATIONof the sclera, the white
fibrous outer layer of the EYE. The inflammation
develops gradually, involving the connective tissue
structure of the sclera. The scleritis may involve a
small portion of the sclera (sectoral scleritis) or the
entire globe of the eye (diffuse scleritis). Some
people develop nodules that may become necrotic
(cause tissue death). Necrotizing scleritis, with or
without nodules, results in severe damage to the
eye (including perforation) and often loss of
vision. More than half of the people who develop
scleritis also have connective tissue disorders, the
most common associations being with RHEUMATOID
ARTHRITISand VASCULITIS.

CONDITIONS OFTEN ASSOCIATED WITH SCLERITIS

ANKYLOSING SPONDYLITIS RHEUMATOID ARTHRITIS
SARCOIDOSIS SYSTEMIC LUPUS ERYTHEMATOSUS(SLE)
VASCULITIS Wegener’s granulomatosis

Deep, aching PAINcharacterizes scleritis, often
severe enough to disrupt sleep. Referred pain
sometimes affects the jaw or cranial bones around
the eye. The affected area of the sclera is erythe-
matous (“bloodshot”), and the eye typically tears
in response to light (PHOTOPHOBIA). The eye may
protrude from the front of the orbit when scleritis
involves the back of the eye. The diagnostic path
typically includes SLIT LAMP EXAMINATIONand OPH-
THALMOSCOPY, and possibly ULTRASOUND to deter-
mine whether the inflammation involves the back
of the eye.
Treatment is topical CORTICOSTEROID MEDICATIONS
and oral NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS), which suppress inflammation as well as
relieve pain. Eye drops to constrict the blood ves-
sels in the eye reduce swelling and redness. Dif-
fuse or severe inflammation may require a

therapeutic course of systemic corticosteroid med-

ication such as prednisone. Prompt diagnosis and

treatment can preserve the eye and vision. How-

ever, permanent structural damage to the eye

with resulting loss of vision is a significant risk

even with treatment. Scleritis may recur when it

is a manifestation of an underlying connective tis-

sue or AUTOIMMUNE DISORDER.

See also CONJUNCTIVITIS; EPISCLERITIS; KERATITIS;

UVEITIS; VISION IMPAIRMENT.

scotoma An area of the RETINAin which there

are few or no cones or rods, the specialized NERVE

cells that convert light signals to nerve impulses,

creating a blind spot in the VISUAL FIELD. Scotomas

may represent healed injuries to the retina such as

retinal tears or degeneration of the retina such as

may occur with AGE-RELATED MACULAR DEGENERATION

(ARMD) or GLAUCOMA. A simple test called the

AMSLER GRID, a grid of equally spaced vertical and

horizontal lines, detects scotomas.

See also RETINOPATHY.

slit lamp examination The examination of the

outer EYEusing a bright light focused into an elon-

gated slit in combination with a biomicroscope.

The examination takes place in a darkened room,

with the person sitting on one side of the slit lamp

and the ophthalmologist on the other side. The

ophthalmologist moves the light across the surface

of the eye to examine the inner eyelids, sclera,

CORNEA, iris, and LENS. The ophthalmologist may

also put drops in the eyes to dilate the pupils, then

use the slit lamp to examine the structures at the

back of the eye, such as the RETINAand OPTIC NERVE,

as well. The bright light of the slit lamp is some-

times uncomfortable as it passes across the eye,

especially with dilated pupils that allow the full

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